Demand for medical training shake-up to care for elderly

Demand for medical training shake-up to care for elderly

Older patients in Scottish hospitals are not receiving the best care available to them at all times and the average support is no longer good enough, a leading expert has warned.

Professor Paul Knight, a consultant at Glasgow Royal Infirmary and the new president of the British Geriatrics Society, criticised the lack of training medical students and junior doctors receive on dealing with the complex needs of the elderly.

Staff failing to assess older patients properly and treat symptoms such as confusion promptly means opportunities to help people return to independent lives can be missed, he said.

He wants care of the elderly to be included in medical training and staffing levels on key wards to be inspected.

Glasgow-trained Professor Knight said: "There is a general attitude in society that is negative towards old people and that percolates.

"Even though older people are our core business, if you look at the curriculum for medical students across medical schools, and to a certain extent nursing as well, a lot of them can get to qualification without really ever having had any structured teaching in what the special needs of older people might be.

"There is a major difference between the best and the average and, on that basis, older people are not getting the best care that is available all the time. My feeling is the average is not good enough any longer because of the number of older people coming through."

He said that while mobility and coherence can deteriorate with age, older patients could become confused or struggle to walk as a result of illness and it was important to differentiate between the two.

If frontline staff decided someone was disorientated because they were older and not because they were ill, he said, an opportunity to intervene and make them better could be missed.

"The window of opportunity for older people is quite narrow, so we do need a general knowledge among staff that says actually we need to think beyond the broken limb," he said.

Mr Knight, a past president of the European Union Geriatric Medicine Society, stressed some hospital services work very well, highlighting evidence that frail pensioners who are appropriately assessed in a well-resourced unit are 25% more likely to be discharged home and be alive in six months than those who receive "ordinary care".

However, Mr Knight added: "It is naive to suggest we can keep everyone at home. We are not likely to do a hip replacement on a kitchen table. On that basis, our services need to be age-attuned and I think they are certainly not as well age-attuned as they could be."

Staff training and attitude as well as the resources available on wards are all key factors, he said.

He called for Healthcare Improvement Scotland, which assesses the hospital care older people receive, to take a view on staffing levels during their inspections.

Doug Anthoney of Age Scotland said: "While there is much good practice and many caring staff, there are also examples of unacceptably poor practice, such as incomplete assessments for cognitive impairment, and some inadequate ward environments."

A spokesman for Healthcare Improvement Scotland said: "Sometimes issues that we've highlighted in our reports reflect how staff are deployed, and we feed any concerns regarding staffing levels back to senior personnel.

NHS boards are responsible for ensuring appropriate and safe staffing levels in their facilities."

A Scottish Government spokesman said: "Delivering quality and compassionate care for older people that protects their dignity and independence is something that we must do well for every older person on every occasion, in care homes and in hospitals." He said that was the reason Healthcare Improvement Scotland was called in.

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